What Chest Pain Means for Athletes

Sports can cause a lot of wear and tear on the body, and sometimes you can feel it in your chest. Athletes such as boxers, football players and lacrosse players often receive hard hits to their chests, which can bruise or fracture their ribs, causing intense pain. Injury to the chest as well as constant repetitive movement with intense training can also cause costochondritis, an inflammation of the cartilage that connects the ribs to the breastbone. It's common in rowers, competitive weightlifters, tennis players, and other athletes.

Meanwhile, any athlete can experience Tietze's syndrome, an inflammatory disorder that affects the chest wall cartilage. And we have all experienced "stitches." Most common when athletes start a training program, these are likely just muscle spasms. Precordial catch syndrome causes sharp localized pains that strike during deep breathing, most often in young adults. While the condition is benign, the cause is unclear.

Athletes are often high achievers, competitive and motivated. However, anxiety and even panic disorders and depression are not uncommon in young athletes. These conditions can result in spikes in heart rate or blood pressure as well as hyperventilation (rapid deep breathing), which can contribute to chest pains. Found in many energy drinks, stimulants like caffeine can speed up the heart, increase blood pressure and contribute to the problem.

You're young. You're an athlete. So why does your chest hurt? After all, don't heart problems strike older, lessactive people? Most of the time, that's true. But no one is immune to heart problems, and symptoms are ignored at our peril. It may surprise you to know that chest pains are actually more common in athletes than they are in sedentary people. Luckily, in young athletes, they typically aren't signs of heart trouble. A medical evaluation can help you be sure. Once heart problems are ruled out, though, determining the exact cause of your chest pains can often be tricky. That's because myriad issues can cause athletes to grab their chests. Check out these common causes of chest pains in young athletes—and learn what you should do if and when pain strikes.

Trauma and Inflammation

Sports can cause a lot of wear and tear on the body, and sometimes you can feel it in your chest. Athletes such as boxers, football players and lacrosse players often receive hard hits to their chests, which can bruise or fracture their ribs, causing intense pain. Injury to the chest as well as constant repetitive movement with intense training can also cause costochondritis, an inflammation of the cartilage that connects the ribs to the breastbone. It's common in rowers, competitive weightlifters, tennis players, and other athletes.

Meanwhile, any athlete can experience Tietze's syndrome, an inflammatory disorder that affects the chest wall cartilage. And we have all experienced "stitches." Most common when athletes start a training program, these are likely just muscle spasms. Precordial catch syndrome causes sharp localized pains that strike during deep breathing, most often in young adults. While the condition is benign, the cause is unclear.

Increased Heart Rate, Blood Pressure, and Breathing

Athletes are often high achievers, competitive and motivated. However, anxiety and even panic disorders and depression are not uncommon in young athletes. These conditions can result in spikes in heart rate or blood pressure as well as hyperventilation (rapid deep breathing), which can contribute to chest pains. Found in many energy drinks, stimulants like caffeine can speed up the heart, increase blood pressure and contribute to the problem.

Gastrointestinal Problems

Athletes are at increased risk of gastrointestinal (GI) issues that cause chest pains. This can be related to the way they eat, what they eat and how they exercise. For instance, athletes often put themselves through periods of fasting and feasting, which can cause stomach upset all by itself.

What's more, gastroesophageal reflux disease (GERD, or heartburn) is common among athletes and is easy to mistake for heart pains (hence "heartburn"). That's because when you're training, food moves more slowly from your stomach into your intestines. Also, in response to training, the small muscular band (sphincter) around the bottom of your esophagus can relax, allowing food and acid in your stomach to rise into your esophagus and cause a burning sensation. And, lastly, tensing your abdominal muscles during exercise increases the pressure in your stomach, thereby forcing your stomach contents up into your esophagus.

Medications you may take for pain such as nonsteroidal anti-inflammatory drugs (aspirin, ibuprofen, naproxen, etc.) can irritate the lining of the stomach, also contributing to GI upset and chest pains.

Lung Problems

When chest pain strikes during or immediately after exercise, the most common cause is spasm of the lungs' small airways. Called exercise-induced bronchospasm (EIB), it can cause sharp chest pains and make breathing difficult. This can often be worse at certain times of the year or when exercising in certain environments. You may need to visit a pulmonologist for adequate testing to determine if EIB is the root of your chest pain. The good news is that treatment often results in improved athletic performance.

Rare, but more serious lung issues include pneumothorax, when air leaks into the space between your lungs and your chest wall, and pulmonary embolism, blood clots in one or more of the lungs' arteries, which can occur after orthopedic surgery or prolonged periods of rest after injury.

In athletes who train or compete outside, exposure to the elements can increase the risk of viral and bacterial lung infections, which can result in either pneumonia or pleurisy, inflammation of the tissues that line the lungs and chest cavity. The inflammation feels like a very sharp pain that is most severe when you breath in.

When Pain Really Hits Your Heart

In athletes 35 and older, the most common cardiac cause of chest pain is angina. Angina is caused by reduced blood flow to the heart muscle as a result of coronary artery disease. The pain is often experienced with exercise and eases up with rest.

In younger athletes, cardiac chest pains are most commonly related to congenital heart defects, meaning you were born with the problem. These include hypertrophic cardiomyopathy, an excessive thickening of the heart muscle—which is the leading cause of sudden cardiac death in young athletes—abnormal locations of the coronary arteries and congenital valvular issues.

However, not all heart conditions that cause chest pains in athletes exist at birth. Myocarditis, an inflammation in the heart's muscle, and pericarditis, inflammation of the membrane that surrounds the heart, are often caused by a virus and can be exacerbated during exercise.

What's more, too-hard tackles and hits can, on rare occasions, cause aortic dissection, a tear in the heart's primary artery. It results in intense, tearing chest pain. This condition is life threatening and needs to be treated immediately.

What to do When Pain Strikes

If you feel a pain in your chest, don't try to just push through it. Stop exercise immediately, let your trainer know what's going on, and follow these tips:

Signs It's an Emergency

If there's no obvious cause for the pain, it doesn't resolve itself quickly, it's associated with fainting, lightheadedness, or an irregular heart beat, or you have a family history of heart disease, you should consider visiting the emergency room immediately.

Signs You Need a Check-Up

Even if the pain lets up, you should make an appointment with a doctor experienced in treating young athletes. He or she will discuss your symptoms with you and evaluate your heart, lung, and gastrointestinal health. If the cause of the pain is still not clear, your doctor may refer you to a cardiologist for further evaluation. Heart problems contribute to only about 5 percent of chest pains in young athletes, but these are the ones no one wants to miss. Athlete or not, chest pains are always cause for concern and deserve prompt medical attention.

Dr. Dermot Phelan
- Dermot Phelan, M.D., Ph.D., is a staff cardiologist and the Director of the Sports Cardiology Center within the Sydell and Arnold Miller Family Heart & Vascular Institute at Cleveland Clinic. His specialty interests include cardiac care of athletes, hypertrophic cardiomyopathy (HCM), valvular he
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